What is HIPAA?
PHP has always recognized the importance of privacy and security of member health information.
In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). This Act established a number of significant regulatory requirements for health plans. Title II of HIPAA deals with, among other issues, the creation of standards for the collection, use, disclosure, and electronic transmission of healthcare information by healthcare providers, health plans, and healthcare clearing houses ("covered entities"). Those provisions are referred to as the "administrative simplification" requirements of HIPAA.
Administrative Simplification Requirements of HIPAA
The major requirements of administrative simplification are:
PRIVACY OF HEALTH INFORMATION
The standards of health information privacy govern the use and disclosure of individually identifiable health information by health plans, healthcare providers, and healthcare clearinghouses and their business associates.
SECURITY OF HEALTH INFORMATION
The security rule provides safeguards for data storage, protection of information transmission systems, and the establishment of chain-of-trust agreements between covered entireties and their business partners.
ELECTRONIC TRANSACTIONS STANDARDS & IDENTIFIERS
This rule establishes standards for eight healthcare transactions (healthcare claims or equivalent encounter information; eligibility for health plan; referral certification and authorization; healthcare claims status; enrollment and disenrollment in a health plan; healthcare payment and remittance advice; health plan premium payments; and coordination of benefits) and designates the code sets used for those transactions.
The identifier rules are intended to establish unique identifiers for employers and providers that will be used in electronic healthcare transactions.